Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3879
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DR.HEALTHCARE & ENROLLMENT)
(479) 204-8550
Entity
Organization
Contact information
Practice address
1495 OBRIE ST, ZWOLLE, LA 71486-2517
(318) 645-9018
(318) 645-9019
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1240
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007044-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149226
PK
—
05
—
2203568
—
LA
Enumeration date
12/04/2014
Last updated
12/31/2015
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